Longitudinal Evolution of Bone Mineral Density and Bone Markers in Human Immunodeficiency Virus–Infected Individuals

Mondy, Kristin; Yarasheski, Kevin E.; Powderly, William G.; Whyte, Michael P.; Claxton, Sherry; DeMarco, Debra; Hoffmann, Mary E.; Tebas, Pablo

doi:10.1086/367569

Cited by 279 publications

(220 citation statements)

References 18 publications

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“…These results strongly support the role of HIV infection in accelerating the development of hemophiliainduced osteoporosis. During the past few years, the impact of HIV infection on bone metabolism has been extensively studied [26][27][28]. Several factors are implicated in the pathogenesis of increased bone resorption observed in HIV-positive patients.…”

Section: Discussionmentioning

confidence: 99%

Increased bone resorption is implicated in the pathogenesis of bone loss in hemophiliacs: correlations with hemophilic arthropathy and HIV infection

et al. 2009

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International audienceOsteoporosis has been recently recognized as a severe comorbidity factor in hemophilia. However, its pathogenesis is still obscure. We evaluated the incidence of osteoporosis in 90 hemophilia patients and investigated possible correlations with clinical and laboratory data. Out of the 90 patients, 80 (89%) had severe hemophilia, and 35 (38.9%) were human immunodeficiency virus (HIV)-positive. Hemophilic arthropahty was assessed using World Federation of Hemophilia clinical score and Petterson radiological score. Bone mineral density of the lumbar spine (LS) and femoral neck (FN) were measured using dual-energy X-ray absortiometry. Bone turnover was evaluated by the measurement of: (1) bone resorption markers [N-terminal cross-linking telopeptide of collagen type I (NTX), C-terminal cross-linking telopeptide of collagen type I (CTX), and tartrate-resistant acid phosphatase isoform-5b (TRACP-5b)], (2) bone formation markers [bone-alkaline phosphatase (bALP) and osteocalcin], and (3) osteoclast stimulators (receptor activator of nuclear factor-κB ligand, osteoprotegerin, and tumor necrosis factor-alpha). Osteopenia or osteoporosis was observed in 86% and 65% of the patients in FN and LS, respectively. Osteoporosis was more common among HIV-positive patients in both FN (65.3% vs 41.6%; = 0.007) and LS (17.86% vs 5.41%, = 0.004). The severity of osteoporosis in FN correlated with the patients' total clinical and radiological score ( = 0.001). Hemophilia patients showed increased osteoclastic activity (significant increase of TRACP-5b, NTX, and CTX), which was not accompanied by a comparable increased bone formation (reduced osteocalcin and borderline increase of bALP). In multivariate analysis, HIV infection ( = 0.05) and total clinical score ( = 0.001) were independent risk factors for osteoporosis development. We conclude that there is a high prevalence of osteoporosis among hemophiliacs, which is related to the severity of arthropathy and is enhanced by HIV infection. We report for the first time a high bone resorption that seems not to be balanced by a comparable bone formation

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Section: Discussionmentioning

confidence: 99%

Increased bone resorption is implicated in the pathogenesis of bone loss in hemophiliacs: correlations with hemophilic arthropathy and HIV infection

et al. 2009

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“…Despite numerous studies suggesting an association between PIs and bone demineralization, recent longitudinal studies of men suggest that certain PI-based antiretroviral regimens may be associated with increases in BMD during short-term follow-up [41,42]. As yet, there is insufficient evidence to conclude that low BMD translates to increased fracture rates in the HIV+ population.…”

Section: Discussionmentioning

confidence: 99%

Bone mass and mineral metabolism in HIV+ postmenopausal women

et al. 2005

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The objective of this cross-sectional study was to estimate the prevalence of and risk factors for osteoporosis in HIV+ postmenopausal women. Bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA) and biochemical indices of mineral metabolism were measured in 31 Hispanic and African American HIV+ postmenopausal women. BMD was compared with 186 historical controls, matched for age, ethnicity and postmenopausal status. Mean BMD was significantly lower at the lumbar spine and total hip in the HIV+ group, as compared with controls. Prevalence of osteoporosis was higher in the HIV+ group than controls at the lumbar spine (42% vs 23%, p=0.03) and total hip (10% vs 1%, p=0.003). Among HIV+ women, time since menopause and weight were significant predictors of BMD, while duration or class of

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“…HIV and ART have both been shown to reduce bone mineral density (BMD), bone mineralization and bone turnover [11][12][13][14][15]. In the general population, it has been postulated that a reduced BMD is associated with a reduced speed of fracture healing [16].…”

Section: Introductionmentioning

confidence: 99%

Fracture management in HIV positive individuals: a systematic review

Wijesekera

Graham

Lalloo

et al. 2016

International Orthopaedics (SICOT)

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Purpose: Human immunodeficiency virus (HIV) infection could potentially play an important role in the management of fractures as they have been shown to affect fracture healing and the post-operative risk of implant sepsis.Methods: A systematic review of the relevant literature was performed on PubMed and Scopus databases. Twenty-six studies were identified, critiqued and analysed accordingly. No randomised controlled trials were identified.Results: HIV positivity was not shown to influence an individual's risk of early wound infection in operatively managed closed fractures. Thank you for your kind comments on our unique systematic review. We have responded to the reviewers and made the changes suggested. Authors' response Many thanks for your comments. The suggested references however interesting, does not seem to cater to this population of interest. The suggested first article focusses on myocardial complications in those undergoing arthroplasty. The second suggested article main emphasis is on spinal trauma and does not refer to the HIV population. Thus we have decided not to go forth inserting these references and no further actions were taken. We do think that these articles are useful and may be included in a future study.Reviewer #2: This is a nice review paper suggesting the well-known fact that there is a place in HIV patients to surgical fixation of fractures.However the authors should: 1) Explain in the "Introduction" and in the "Discussion" the meaning of ART and the new development in this mode of treatment and describe the change in morbidity and mortality in HIV patients" in the last few years and the relation of this change to their findings Authors' response Many thanks for your comments. We agree that a further explanation on ART should be included to the reader. This was included in the "Introduction." Clarification on the morbidity and mortality reduction since the introduction of ART in HIV infected patients was also included. Regarding discussing the new developments in ART, this is a whole topic in itself and beyond the scope of this review. However, we are currently finalising a similar systematic review focusing on the effect of ART on bone metabolism and fracture healing which we will submit for consideration for publication in your journal soon. Authors' action Powered by Editorial Manager® and ProduXion Manager® from Aries Systems CorporationThe following changes have been made; The introduction of Anti-Retroviral Therapy (ART) in 1997 altered the course and nature of patients infected with HIV by increasing the duration of asymptomatic infection and increasing life expectancy [2,3]. ART is a combination of medication given to those affected with the disease. This suppresses the viral load and improves the patient immunological status [4]. A 50% reduction in morbidity and mortality has been reported in those with a CD4 T-cell count of >500cells/mm3 and have been started on ART promptly [5,6]. However, despite near normal life expectancy, there is little evidence to...

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Longitudinal Evolution of Bone Mineral Density and Bone Markers in Human Immunodeficiency Virus–Infected Individuals

Cited by 279 publications

References 18 publications

Increased bone resorption is implicated in the pathogenesis of bone loss in hemophiliacs: correlations with hemophilic arthropathy and HIV infection

Increased bone resorption is implicated in the pathogenesis of bone loss in hemophiliacs: correlations with hemophilic arthropathy and HIV infection

Bone mass and mineral metabolism in HIV+ postmenopausal women

Fracture management in HIV positive individuals: a systematic review

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